Health and Wellness

Health Education and Programs

Gold Coast Health Plan offers free health education services to help Members achieve a healthy lifestyle. Health education services are designed to ensure that all Members have access to health education programs, health promotion materials and classes.

We make certain that health education services are accessible to our Members by collaborating with local health agencies, clinics, hospitals and Primary Care Providers (PCPs).

To request health education services, contact us at 888.301.1228 or download the Health Education Referral Form.

Health Education Referral Form

Our programs are constantly changing to ensure that we meet the health education needs of our Members and Providers. So check out the calendar of health education topics, locations and classes for the latest information about our programs and events.

Disease Management

GCHP has a free Disease Management Program for Diabetes for:

  • Members with diabetes.
  • Members at risk of getting diabetes.

The program connects members and their families with:

  • Resources in English or Spanish.
  • Classes near home or work.
  • A Nurse Coach for one-on one help
    • Reaching goals.
    • Making lifestyle changes.

Members

Our Members-first focus is at the core of everything we do. It means providing services and resources to our Members whenever there is a need. Our Health Services team is right here in Ventura County and can answer your questions in both English and Spanish. We can also provide you with health education materials, pharmacy information and much more.

Community Resources: Community Resources provides Members with helpful information like useful web links, supporting agencies and contracted hospitals.

Care Management: Care Management empowers Members to exercise their options and access the services they need.

Cultural and Linguistic Services: Cultural and Linguistic Services enhances communication, cultural understanding and advances learning to our multilingual membership.

Disease Management: Disease Management provides targeted interventions to Members with certain high-risk diseases.

E-newsletters: Subscribe to our e-newsletters to receive information on health, pregnancy or being a new parent.

Health Library: Search more than 100 topics and interact with health tools in our health library.

Staying Healthy: Staying Healthy Assessment helps identify high-risk behavior in Members, sets priorities for behavior change and refers patients for appropriate services.

Providers

We work in partnership with more than 3,600 doctors, 187 pharmacies and most of the local hospitals and long-term care facilities in Ventura County. A representative from Health Services is available to assist you with your healthcare needs. From routine checkups to medical emergencies, we are here to help you manage your caseload.

Utilization Management: Utilization Management provides continuity of care, coordination of services and improved health outcomes for Members.

Palliative Care

What is the MyGoldCare™ program?

MyGoldCare is Gold Coast Health Plan’s palliative care program that is available for qualified Plan members.

Palliative care is specialized medical care for people with a terminal illness. It is a way of providing care that addresses the difficulty of treatment with a unique focus on patient choice and improving quality of life for both the patient and the family. A palliative care team works with patients and families to determine what is most important to them in managing their illness. This type of care is focused on providing relief from the symptoms, reducing the stress of a serious illness, and addressing the physical, intellectual, emotional, social and spiritual needs of GCHP’s members in the most compassionate way possible.

Palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work with the patient’s other doctors to provide an extra layer of support and ensure that the patient’s and family’s goals of care align with the treatment options available to them.

More information on MyGoldCare:

VC Star Article
MyGoldCare Palliative Care Program Changes – Effective January 1
For Providers: Frequently Asked Questions About Palliative Care Services for GCHP Members

How does a member qualify?

GCHP will provide palliative care services to all members who elect and qualify under the general eligibility and disease-specific criteria of the MyGoldCare program. A provider memorandum that provides descriptions of the covered conditions is located here on the GCHP website.

Qualified conditions include, but are not limited to, advanced cancer, kidney failure, chronic liver disease, chronic obstructive pulmonary disease (COPD) and congestive heart failure. If a GCHP member continues to meet the eligibility criteria, they may continue to access both palliative care and curative care.

If you believe a patient qualifies for MyGoldCare, the referring provider can refer directly to one of GCHP’s MyGoldCare palliative care providers. A prior authorization is not required for palliative care.

Resources for Providers

General Information

  • What is the difference between palliative care and hospice?
    Palliative care is used while patients continue active treatment for their medical conditions. Hospice care is reserved for terminally ill patients when treatment is no longer curative during the last six months of life. A patient can receive curative treatment and palliative care treatment at the same time.

Advanced Care Planning (ACP)/Communication

Physician Orders for Life-Sustaining Treatment (POLST) Information

Resources Available for Staff

  • Palliative Care Education: The California State University Institute for Palliative Care has received funding from the state Department of Health Care Services (DHCS) to support the education of Medi-Cal providers in how to deliver palliative care. Free of cost for a limited time.
  • Ventura County Coalition of Compassionate Care (VCCCC): VCCCC is a local coalition dedicated to promoting education to health care professionals and the public regarding advance care planning and the understanding of life-sustaining treatments for those with serious illness. You can connect with other professions dedicated to compassionate care and stay up-to-date on relevant resources, policies, and legislation that may impact you and your organization.
  • Centers to Advance Palliative Care (CAPC): The Center to Advance Palliative Care (CAPC) is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious illnesses.
  • National Hospice and Palliative Care Organization: An organization that represents hospice and palliative care programs and professionals in the United States.
  • Palliative Care and Senate Bill 1004: SB 1004 requires the state Department of Health Care Services (DHCS) to “establish standards and provide technical assistance for Medi-Cal managed care plans to ensure delivery of palliative care services.”

Other Resources for Members

  • Ventura County Health Care Agency’s In Home Support Services (IHSS) Program: This program helps seniors and people with disabilities (including children) to stay in their homes. Help is available for qualified applicants to pay for support services, including light domestic help, non-medical personal care, and assistance to and from medical appointments.
  • Ventura County Health Care Agency’s Whole Person Care Pilot Program: The program helps members facing complex medical and social challenges to secure necessities, such as housing, food, and reliable transportation to doctor’s appointments. For more information, contact the Ventura County Health Care Agency at 1-805-339-1122.

Disease Management

Gold Coast Health Plan (GCHP) has Disease Management Programs for Asthma, Diabetes and Pre-Diabetes.

The goal is to improve the health of our members. Members with asthma, diabetes or who are at risk for getting diabetes are encouraged to join.

Members have access to:

  • Educational materials in English or Spanish.
  • Coaching by a nurse, if eligible, to make lifestyle changes.
  • Classes in English or Spanish, when available, near home or work.

The program works with primary care providers, specialists and members to improve health outcomes. It can also help reduce or delay long-term complications by supporting member efforts to live a healthier lifestyle.

Providers

Disease Management

GCHP aims to improve the health of its members and their families by partnering with its network of providers to deliver evidence-based care.

The Disease Management Program is a free service for members that provides them with targeted interventions to help manage chronic conditions like asthma, diabetes and pre-diabetes. The goal of the program is to work with primary care providers, specialists and members to identify the best ways for members to stay as healthy as possible, reduce or delay long-term complications and manage the member's conditions with appropriate care for the best health outcomes. The Program offers members the following free services:

  • Educational materials and links to resources in either English or Spanish.
  • Access to work with a Nurse Health Coach on mutually agreed-upon goals.
  • Classes taught in English or Spanish near the member’s home or work, when available.

For more information, here are some helpful links:

Disease Management Referral Form

American Diabetes Association’s 2019 Standards of Medical Care in Diabetes

Guidelines for the Diagnosis and Management of Asthma (EPR-3)

EPA Air Quality Index

Sample asthma action plans in English and Spanish from the National Heart, Lung, and Blood Institute (NHLBI).

Asthma Action Plan

Plan de acción para el control del asma

Members

Set Your Own Goals for Good Health

Be your best healthy self. If you or someone in your family has asthma, diabetes or is at risk for developing diabetes, GCHP’s Disease Management Programs are here to help you.

In the program, you can learn how to:

  • Get the care you need.
  • Understand the care your doctor recommends.
  • Manage health issues for you and your family.
  • Learn about other things you can do to stay healthy.

GCHP's Disease Management Team Supports a Healthier You

GCHP's focus is on you and your family. The Plan’s goal is to make it easier for you to manage your health and live your life well. GCHP’s nurse coaches and health educators can help you stay healthy with:

  • One-on-one help.
  • Free learning materials in English and Spanish.
  • Access to free English or Spanish classes in the communities near you, when available.
  • Online resources.

GCHP Wants to Help You Protect Your Health

Another way the Plan helps is by putting information to work for you. GCHP compares your health records to current recommendations and can:

  • Help you get any care that you are missing.
  • Remind you to get the preventive care you and your family need.
  • Make sure you are taking the right medications.
  • Tell your doctor how you are doing.

Getting Started is Easy and Free

The program is already part of your GCHP health benefit. We would like to hear from you so that we can help you get connected with:

  • Educational materials in English or Spanish.
  • Classes in English and Spanish near your work or home, when available.
  • A nurse coach to design a plan of action to keep you and your family healthy.

Call 1.805.437.5588/TTY 1.888.310.7347 and get started today! You can stop the program at any time.

Member Community Resources

Health Education Program

Gold Coast Health Plan's Health Education Program is committed to helping you stay well. We work with local clinics, Providers and hospitals to provide quality health education resources to Members.

No prior authorization is necessary for Members to attend health education and health promotion activities.

There is no cost to you. All health education materials are free of charge to Members.

Call for more information about programs and materials. Health education materials are available in English and Spanish.

Health Education Resources

Community Resources – Ventura County

Community Resources – Seniors

Health Education Referral Form

Contact Us
Lupe Gonzalez, PhD, MPH
Director, Health Education, Outreach and Cultural & Linguistics Services
888.301.1228
Fax: 805.437.5134
healtheducation@goldchp.org

Cultural and Linguistic Services

How to Access Cultural and Linguistic Services
It is important to use a professional interpreter at your medical appointment. GCHP discourages members from using family or friends, especially children, as interpreters. GCHP's Cultural and Linguistic Services is here to help you. Call Member Services at 888.301.1228; TTY: 888.310.7347, if you would like more information or send us an email at CulturalLinguistics@goldchp.org.

GCHP offers the following interpreter and translation services:

  • Sign language interpreter services for the deaf
  • Telephonic interpreter services are available twenty-four (24) hours, seven (7) days a week
  • In-person (face-to-face) interpreting services – 5 to 7 business day notice is needed to schedule an appointment for in-person interpreter for medical appointments
  • Translation of written documents (English/Spanish)
  • Alternative text format including Braille

Supporting Agencies

Ventura County Women, Infants and Children (WIC)
800.781.4449 (option 3)
wic.program@Ventura.org

California Children's Services (CCS)
805.981.5281

Child Health & Disability Prevention (CHDP) Program of Ventura County
805.981.5291

Comprehensive Perinatal Services Program (CPSP)
805.981.5144
Fax: 805.981.5385
estella.sweeney@ventura.org

Ventura County Behavioral Health Department (VCBHD)
805.981.6830

Tri-Counties Regional Center (TCRC) for Developmentally Disabled/Delayed
805.485.3177

Ventura County Public Health Department (VCPHD)
805.981.5101

Member Care Management

GCHP Care Management is a collaborative process that includes telephonic contact with the member and communication with the medical management team, led by the primary care provider.

Members eligible for care management services may include those with:

  • Multiple medications and difficulty with adherence
  • Non-adherence to the medical treatment plan
  • Psychosocial barriers that may prevent progress
  • Resource barriers and need assistance from a social worker
  • Organ transplant
  • High risk pregnancy
  • Catastrophic or medically fragile conditions
  • Frequent hospital admissions
  • Frequent emergency room visits for non-emergent care
  • Coordination of care issues

Care Managers accept referrals from plan providers, hospital case managers, self-referrals from members and community agencies.

The care management process includes:

Assessment

  • Individual needs based on a comprehensive evaluation
  • Barriers to adherence with treatment plan identified

Planning

  • A member-centric care plan is formulated based on member understanding
  • Opportunities for improvement, goals and collaborative approaches to evidence-based interventions are explored

Coordination

  • Coordination of care and integration of services across a range of settings
  • Collaboration with member, family, member’s representative, primary care physician and other members of the health care team

Monitoring and Evaluation

  • Reassessment to determine if desired outcomes and goals of care plan have been met is done per member and care manager agreement
  • Revisions to the care plan are consistent with the dynamic needs of the member

Advocacy

  • The care manager serves as a member advocate by providing support and education to empower members and families to become self-reliant in managing the disease process
  • Care managers practice cultural sensitivity and work effectively within the member's cultural context

GCHP Care Management referral form

This fillable form can be completed and emailed to caremanagement@goldchp.org or faxed to 855.883.1552.

E-newsletters

It's easy to subscribe to our e-newsletters. Just click on one of the links and then fill out the required information. You can unsubscribe at any time. Because we respect your privacy, we won't share your email address.

Pregnancy

Expectant mothers (and fathers) can choose our weekly Pregnancy e-newsletter. This newsletter leads you through the various stages of pregnancy, offering timely tips, articles and practical interactive tools that can help take some of the worry out of this time in your life.

Subscribe to our Pregnancy e-newsletter

New Parent

Welcome to parenthood! Now that your precious one is in your arms and growing quickly, you may have questions regarding your child's development as well as issues you experience along the way. This e-newsletter is designed specially for new parents. Once a month you will receive timely information related to the growth of your baby. The New Parent e-newsletter provides information to parents from your child's birth through the first three years.

Subscribe to our New Parent e-newsletter

Growing Up Healthy

“Growing Up Healthy” and “Staying Healthy” Education Materials

The Child Health and Disability Prevention (CHDP) Program provides important information for parents on the health, nutrition, dental care, and safety of their children. The program brochures also explain what parents can expect from the time when their children are born up until the age of 20.

To access the “Growing Up Healthy” and “Staying Healthy” brochures, click on the age-appropriate group below:

Growing Up Healthy
Birth to 2 months
3 to 4 months
5 to 6 months
7 to 9 months
10 to 12 months
13 to 15 months
16 to 23 months
2 years
3 years
4 to 5 years
6 to 8 years
9 to 12 years

Staying Healthy
13 to 16 years
17 to 20 years

Health Library

Find reliable health information.

Health Library

Staying Healthy Assessment

Staying Healthy Assessment (SHA) Tool

All Gold Coast Health Plan Members are required to have a Staying Healthy Assessment (SHA) within 120 days of enrollment. The SHA can help Providers identify high-risk behavior, set priorities for behavior change and refer patients for appropriate services.

Below is a current schedule and protocol for administering the SHA tool.

Gold Coast Health Plan Members will be asked to fill out the age/language specific Staying Healthy Assessment form at the Initial Health Assessment (IHA), within 120 days of enrollment or well-care visits at your office.

Staying Healthy Assessment

Children

0 to 6 Months

7 to 12 Months

1 to 2 years of age

3 to 4 years of age

5 to 8 years of age

One assessment for each age group, completed by parent or guardian, signed and dated by Primary Care Provider (PCP). Reviewed, dated and initialed by PCP annually thereafter.

Pre-adolescents

9 to 11 years of age

Adolescents

12 to 17 years of age

Self-administer. Reviewed, dated and initialed by PCP annually thereafter.

Adult

18 years of age and older

Self-administered, every 3 to 5 years up through age 55.

Senior

Senior age 56 and above

After age 65, self-administer per recommendation by PCP.

Complete set of SHA forms

Provider Utilization Management

The Utilization Management (UM) Program goal is to provide continuity of care, coordination of services and improved health outcomes, while increasing the effectiveness and efficiency of services provided to Members.

Licensed nurses may authorize services under the direction of the medical director, but they do not make medical necessity denial decisions. They apply UM criteria to make decisions and utilize their clinical knowledge while considering the individual needs of the Members. The Plan’s medical director is available to the nurses for consultation and to make medical necessity denials.

Health Services is committed to ensuring medically necessary quality care in appropriate settings. UM nurses and Providers—working closely with hospital staff and attending Providers—perform pre-service review, concurrent review and post-service review, utilizing nationally recognized, evidence-based criteria adopted by our network of Providers, ensuring that services being performed and medical equipment being ordered are appropriate.

Utilization Management Guidelines

Administrative

Decision-Making Resources Guideline

Utilization Management Guideline

Medicine

Botox Supplemental Clinical Guideline

Chiropractic Services Guideline

Custodial Care Guideline

Genetic Testing Guideline

Home Enteral Nutrition Guideline

Intravenous Sedation and General Anesthesia for Dental Services Guideline

Nusinersen / Spinraza Guideline

Physical, Occupational, and Speech Therapies for Children under the Age of 21 Years Guideline

Transgender Services Guideline

Rehabilitation Therapy

Acute Inpatient Rehabilitation Guideline